SB3733 101ST GENERAL ASSEMBLY

LRB101 19166 BMS 68629 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3733

Introduced 2/14/2020, by Sen. Andy Manar

SYNOPSIS AS INTRODUCED:

215 ILCS 5/155.37

Amends the Illinois Insurance Code. Provides that if a generic equivalent for a brand name drug is approved by the Food and Drug Administration, insurance companies with plans that provide coverage for prescription drugs through the use of a drug formulary that are amended, delivered, issued, or renewed in the State on or after January 1, 2021 shall immediately substitute the brand name drug with the generic equivalent or move the brand name drug to a formulary tier that reduces an enrollee's cost. Grants rulemaking authority to the Department of Insurance. Defines "brand name drug", "generic drug", and "formulary". Effective January 1, 2021.

FISCAL NOTE ACT MAY APPLY

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Insurance Code is amended by changing Section 155.37 as follows:

(215 ILCS 5/155.37)

Sec. 155.37. Drug formulary; notice.

(a) As used in this Section:

"Brand name drug" means a prescription drug marketed under a proprietary name or registered trademark name, including a biological product.

"Generic drug" means a prescription drug, whether identified by its chemical, proprietary, or nonproprietary name, that is not a brand name drug and is therapeutically equivalent to a brand name drug in dosage, safety, strength, method of consumption, quality, performance, and intended use. "Generic drug" includes a biosimilar product.

"Formulary" means a list of prescription drugs that is developed by clinical and pharmacy experts and represents the carrier's medically appropriate and cost-effective prescription drugs approved for use.

(b) Insurance companies that transact the kinds of insurance authorized under Class 1(b) or Class 2(a) of Section 4 of this Code and provide coverage for prescription drugs through the use of a drug formulary must notify insureds of any change in the formulary. A company may comply with this Section by posting changes in the formulary on its website.

(c) If a generic equivalent for a brand name drug is approved by the Food and Drug Administration, insurance companies with plans that provide coverage for prescription drugs through the use of a drug formulary that are amended, delivered, issued, or renewed in this State on or after January 1, 2021 shall:

(1) immediately substitute the brand name drug with the generic equivalent; or

(2) move the brand name drug to a formulary tier that reduces an enrollee's cost.

(d) The Department of Insurance may adopt rules to implement this Section.

(Source: P.A. 92-440, eff. 8-17-01; 92-651, eff. 7-11-02.)

Section 99. Effective date. This Act takes effect January 1, 2021.